CARE HOMES FOR OLDER PEOPLE
The Lilacs Resource Centre The Lilacs Resource Centre Warwick Road Scunthorpe North Lincolnshire DN16 1HH Lead Inspector
Beverley Hill Unannounced Inspection 24th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Lilacs Resource Centre Address The Lilacs Resource Centre Warwick Road Scunthorpe North Lincolnshire DN16 1HH 01724 869635 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) North Lincolnshire Council Jacqueline Mary Campbell Care Home 30 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (6) The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. Twenty four (24) in category DE (E) to be accommodated in units 3, 4 and 5 Unit 1 (Dove Suite) to only be used for Six (6) OP and/or PD (E) for the provision of intermediate care Only unit 2 lounge area may be used to accommodate up to 8 day care service users. Bedrooms in unit 2 may only be used to accommodate service users when the Commission has confirmed this area fit for purpose. The bungalow in the grounds may only be used to accommodate service users when the Commission has confirmed this area fit for purpose. 9th November 2005 Date of last inspection Brief Description of the Service: The Lilacs is a purpose built home owned and managed by the local authority. It is situated near to the centre of Scunthorpe and close to local amenities, rail and motorway links. The home provides ground floor accommodation for a total of thirty service users. Twenty-four people, over the age of 65years who may have needs associated with dementia, can be accommodated in the main unit and six people who have intermediate care needs in the Dove Suite. Day care is also provided for up to eight service users and there are people whose needs are met with regular respite breaks. The home is divided into five units. Unit one is the Dove Suite, a separate unit, which contains six en-suite bedrooms, a lounge, a bathroom and shower room, an assisted toilet and a rehabilitation kitchen. Unit two is mainly used for storage and offices and units three, four and five are for service users. All bedrooms are single and the main unit has two assisted bathrooms, an assisted shower room and eight single toilets throughout. In addition there are two lounges, a combined lounge/dining room and a separate dining room. There is also a designated smokers lounge and various smaller communal rooms for visitors, the hairdresser and therapies. The central garden space is accessible to service users and has been improved to make a more attractive area. The enclosed, paved area consists of a water feature, mature shrubs and seating. All areas of the home are accessible to service users via wide corridors and ramps.
The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 5 The focus of the home has gradually changed and the home accommodates more short-term care such as respite and intermediate care. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over four hours. The Inspector spoke to the manager, the administrator, a senior care officer, a care worker and an ancillary staff member that was on duty at the time of the inspection. Throughout the morning the inspector spoke to five service users. The inspector looked at a range of paperwork in relation to quality monitoring, the management of finances, staff recruitment, staff training, care plans and management of service users health needs. The Inspector also checked that people who lived in the home had the opportunity to suggest changes and were listened to. The Inspector completed a partial tour of the building and checked to see that the requirements issued at the last inspection had been met. What the service does well:
The manager and staff team worked very hard in planning and organising all the admissions and discharges that happen at The Lilacs whilst making the service users who lived there permanently feel that it is their home. The home is used for people who may have a crisis at home or who may need to go somewhere quickly for an assessment and only seven people live there permanently. The staff team had developed a good working relationship with health professionals who visited the home and held a regular meeting to support carers. Staff spoken to felt the home had a reputation for good care and were proud of this. They enjoyed the work and felt it was a friendly team. Most of the staff team had worked at the home for several years and knew the service users well. People who stayed at the home said that the staff members, ‘go out of their way to help you’, were ‘patient and caring’, ‘nice girls’ and that they respected their privacy and dignity. One person said, ‘they put the word in caring’. The home provided a pleasant and clean environment. It was decorated to a good standard and there were areas throughout where people could sit quietly or congregate for activities. People spoken to stated that the meals were very good. They had two choices at lunchtime and had plenty to eat and drink. If they didn’t like the choice on offer they could have an alternative. The home managed service users finances well.
The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Service users were only admitted to the home after an assessment of their needs had been completed and in emergencies staff gathered sufficient information to enable a decision to be made about whether the home was able to meet needs. EVIDENCE: The home had an admissions policy and procedure that included emergency admissions and this guided practice. The staff team completed in-house assessments built on those produced by care management, which were obtained by the home prior to admission. The assessments were important as they provided vital information for the care planning stage. During emergencies the staff used an information-gathering tool that helped them determine whether the home could meet needs. As the home was used by care management to place people due to family crises this was particularly important. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 10 The homes assessment and information-gathering documentation had been reviewed recently and covered all the required points highlighted in the standard. The manager routinely wrote to service users or their representatives following the assessment to state formally the homes ability to meet needs. The staff members spoken to had described that they helped in the admission process by unpacking for people, settling them in, showing them around and introducing them to other service users. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Service user health, personal and social care needs were identified and met, promoting privacy and dignity in the process. EVIDENCE: Standards 7 and 9 were assessed at the last inspection but re-visited on this occasion to check that requirements made had been met. Improvements were noted in the care plans examined. They had clear tasks for staff and addressed all aspects of health, personal and social care needs. They were signed and dated by the person formulating the care plan and evaluated monthly. Recording of the daily care provided had improved and each section of the care plan was commented on. The home had reviewed their policy and procedure regarding supervision arrangements for service users who wished to continue managing their own medication after admission. The system would ensure the ongoing monitoring and safety of service users whilst encouraging independence. The home demonstrated via documentation and discussion with service users and staff that health care needs were met. Each care plan had specific health care monitoring sections as required and input from health care professionals
The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 12 was evidenced and recorded. Risk assessments were completed and crossreferenced with the care that was planned for the service users. Staff members spoken to were clear about how they promoted the health and welfare of service users and described reading and following care plans and risk assessments, the importance of recording and communication at all levels, the development of good working relationships with professionals and generally getting to know service users. This was acknowledged as difficult at times due to the nature of short stays. Service users spoken to state their health and personal care needs were met and described care that promoted privacy and dignity. They described how staff knocked on doors prior to entering, left them to get on with personal care tasks if they were able, assisted them sensitively and enabled them to see visitors or the doctor in private. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 The home provided a good quality of life for service users by providing social stimulation and promoting choice and decision-making. EVIDENCE: Those service users who lived permanently at the home had quite complex needs and most were unable to make choices about their lives. Staff described having to make choices for some people, for example about the clothes they wear but they tried to enable those who could make choices do so by holding up two items of clothes for their decision. Service users preference for certain activities was noted in assessments and care plans. Care plans reflected the need to encourage independence and promote choice. Service users spoken to were mainly those who attended for respite care or day services. People said they could rise and retire at their leisure, see their visitors at any time, had choices about meals and drinks throughout the day and could choose whether to join in the activities. The routines were described as, ‘relaxed’. One person informed the inspector that they had asked for a specific chair to be put in their bedroom during their stay and this had been accommodated. Some people on respite chose to manage their own medication and finances. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 14 A range of activities was provided and posters of events displayed. Various staff including the cook provided social stimulation in the form of baking, dominoes, bingo, hand and nail care, carpet bowls, cards, crafts, one to one chats and exercises. The home had visiting entertainers, library and talking book services and visits from local clergy. Some service users spoken to enjoyed banter with staff and another said it was sometimes difficult to get people interested in things like dominoes. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home protected service users from abuse by training staff, maintaining good care practices and adherence to policies and procedures. EVIDENCE: There was evidence that staff members were recruited appropriately with references and criminal record bureau checks, received training in the protection of vulnerable adults and how to manage challenging behaviour and were aware of what to do in the event of any suspected abuse. Practices were guided by robust adult protection policies and procedures. The manager and senior staff members were aware of referral and investigation procedures. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 25 The home provided an environment for service users, which was safe, comfortable and well maintained EVIDENCE: The home had access to the local authority maintenance sections for any repair and redecoration of the home and the manager was proactive in monitoring the environment for shortfalls. Communal and individual bedrooms were notably clean and pleasantly furnished and decorated. Those service users who resided at the home on a permanent basis had bedrooms that were personalised to varying degrees. Those who were admitted for respite care tended to bring with them a range of their own items they required for the short stay including televisions and radios. The bedrooms had privacy locks and lockable facilities. The Dove Suite, which provided intermediate care services was a relatively new unit and was furnished and decorated to a high standard. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 17 All entrances to the home had ramps for wheelchair users and service users had access to inner secure areas with garden furniture and water features. Since the last inspection laundry services had improved and an extractor fan had been installed in the smoke room. The home was a purpose built, ground floor unit and was suitable for its intended purpose. Since the last inspection staff have been reminded to activate the coded locks on the sluice doors when not in use to ensure service users could not gain access. Hot water outlets accessible to service users had been fitted with thermostatic valves to ensure safety and prevent scalding. The home was suitably warm. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 29 Progress had been made in NVQ training and trained staff supported service users. Consistent exploration of gaps in employment during recruitment processes would add to the robustness of the homes systems to protect service users. EVIDENCE: The home generally had robust recruitment procedures and appropriate checks and documentation was in place prior to the start of employment. Two new staff files were examined and although criminal record bureau checks were completed corporately the manager was notified of the outcome. One of the files examined had two gaps in employment that had not been recorded. It was important that these were explored with staff during the recruitment process and documented. The home had focussed on NVQ Level 2 and 3 training and this had resulted in them exceeding by 3 , the target of 50 of care staff trained to NVQ Level 2, which was a good achievement. Staff spoken to stated they had access to a range of training courses and were encouraged to participate. They felt skilled to complete the tasks required of them. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 35 Service users were consulted about the quality of care provided and their safety and wellbeing were promoted by the style of management within the home. Inconsistent evaluation of the effectiveness of action plans produced to address shortfalls in service could result in the shortfall continuing. EVIDENCE: The manager was a qualified social worker and had completed a certificate in management. During the last year training had included diversity for managers and the single assessment process. The manager demonstrated leadership and guidance and staff members spoken to felt supported and valued. Staff members were positive about the managers’ style and the inspector had found that requirements issued at inspections were always addressed via clear action plans.
The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 20 The home had achieved a gold standard for quality monitoring from the local authority and were awaiting a reassessment. The quality assurance system consisted of questionnaires to service users, relatives, professional visitors and staff. The home had introduced a feedback form for service users who use the respite services. Results of questionnaires and surveys were collated, analysed and displayed in the home. The manager confirmed that they were reviewing the display of results to ensure they provided information but did not affect the ‘homely’ nature of the home. Audits were also completed weekly and monthly. Action plans were formulated to address any shortfalls from questionnaires and audits but the inspector was unable to see if the action plans were evaluated for effectiveness. This would complete the quality assurance system. An annual service review was completed by the manager and made available in the home. A copy was forwarded to CSCI. The home managed the finances of two service users and held a small amount of personal allowance for five other people. These, and the service users comfort fund, were checked and were managed appropriately. The amount of service users who deposited personal allowance for safekeeping fluctuated due to the numbers of people who used the respite service. Clear records and receipts were maintained. Lockable facilities were available for service users to manage their own finances. The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X 3 X STAFFING Standard No Score 27 X 28 4 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X X The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 Requirement The registered person must ensure that during the recruitment process gaps in employment history are consistently explored and documented. The registered person must ensure that action plans to address shortfalls in service are evaluated for their effectiveness. Timescale for action 31/03/06 2. OP33 24 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Lilacs Resource Centre DS0000033138.V285431.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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